The Respiratory System - Bronchodilators and Corticosteroids
Roach, Chapter 37
What is a bronchodilator?
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A bronchodilator is a drug used to relieve bronchospasm associated with respiratory disorders. A bronchodilator dilates the bronchi and bronchioles, decreasing airway resistance and thereby facilitating airflow.
What respiratory diseases or disorders are commonly treated with a bronchodilator?
Albuterol (Ventolin) is an example of a sympathiomimetic bronchodilator (mimics the effects of the sympathetic nervous system). What other drug have you learned about that also mimics the sympathetic nervous system?
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Epinephrine (Adrenaline)
What is the inverse relationship of a bronchodilator and cardiovascular function?
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Drugs causing bronchodilation cause vasoconstriction, thus elevating blood pressure, and also increase heart rate. Think epinephrine. Recall that epinephrine is given in emergency situations to open airways and increase blood pressure and pulse rate.
Drugs causing bronchoconstriction cause vasodilation, thus lowering blood pressure, and also decrease heart rate. Think metaprolol. Recall that one of the nursing considerations of a person receiving a beta-blocker was to monitor lung sounds for wheezing.
Bronchodilation is accompanied with vasoconstriction. Vasoconstriction is accompanied with bronchodilation. Bronchoconstriction is accompanied with vasodilation. Vasodilation is accompanied with bronchoconstriction.
Given this information, what two side effects are associated with bronchodilators?
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Hypertension and tacchycardia. Other side effects include nervousness, insomnia, anorexia, nausea, and vomiting. These other side effects are also associated with COPD diseases, so it may be difficult to tell whether the drug is causing the side effects, the disease is causing the side effects, or, more probably, the tremors, irritability, and nausea or being caused by both disease and drug.
How is albuterol (Ventolin) administered?
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Albuterol is administered as an aerosol. It can be given via metered-dose inhaler (MDI) or by nebulizer.
What is a corticosteroid?
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Corticosteroids act to decrease the inflammatory process in the airways. They may also be used prophylactically to prevent inflammation. You learned about the corticosteroid Prednisone in the last unit. Corticosteroids used to treat respiratory inflammation are often adminstered as an aerosol.
What respiratory diseases or disorders are commonly treated with an inhaled corticosteroid?
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Asthma
COPD
What are the side effects of a corticosteroid inhalant?
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Throat irritation
Hoarseness
Cough
Fungal infection of mouth or throat
Vertigo
Headache
Fluticasone propionate (Flovent) is an inhaled corticosteroid. Why aren’t the side effects of fluticasone propionate (Flovent) the same as the corticosteroid Prednisone?
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Inhaled corticosteroids produce a local effect and not a systemic effect. The systemic effects, those Cushing Sydrome like effects (fluid retention, hypertension, endocrine changes, altered fat and glucose metabolism, etc.), are less likely to occur with an inhaled corticosteroid than with that of an oral or injected corticosteroid.
How is fluticasone propionate (Flovent) administered?
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Fluticasone is administered via a metered-dose inhaler (MDI).
What is a Metered-Dose Inhaler (MDI)?
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The metered-dose inhaler (MDI) is an aerosol and currently one of the most common types of inhaler. The medication comes out of the inhaler as a mist or spray.
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How is an MDI administered?
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1. Shake the inhaler well for 5 to 10 seconds immediately before use.
2. Remove the cap from the mouthpiece.
3. Exhale completely.
4. Hold the inhaler system upright.
5. Place the mouthpiece into the mouth and close lips.
6. Press the top of the inhaler while taking a slow, deep breath.
7. Hold the breath for 10 seconds before slowly exhaling.
8. If more than one inhalation (puff) is required, wait about one minute between.
9. Rinse the mouth after use.
10. Cleanse the mouthpiece.
An aerochamber attaches to the MDI. It is designed to maximize the delivery of metered-dose inhaler medications to patients' lungs. Aerochambers deliver more medication to the lungs with less medication sticking in the mouth and throat. (See Roach p. 385)
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How is an aerochamber (spacer) used?
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The aerochamber is attached to the metered-dose inhaler (MDI) prior to its administration. The steps are the same as for the MDI. Cleanse the mouthpiece of the aerochamber (spacer) after use. The aerochamber (spacer) may be rinsed, but then allow to air dry. Wiping dry will cause static electricity within the chamber, trapping the aerosol particles within.
When both medications are ordered, why should the bronchodilator be given before the corticosteroid?
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Bronchodilation opens up the airways, allowing for deeper penetration into the bronchioles of the corticosteroid.
How can you tell when a canistor is nearly empty?
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Patients were taught in the past to ‘float’ the canistor in water. The heavier, fuller canistor will sink to the bottom. The lighter, emptier canistor will float. This practice is no longer endorsed. Floating has been proven to be inaccurate with empty canistors sinking. The moisture is also harmful to the aerosol products. Even though your textbook shows you this method, DO NOT follow this advice. Instead, best practice is to keep track of the number of administrations or presses. By FDA regulations, each canistor must be clearly marked with the number of administrations it holds. Divide that number by the number of administrations prescribed per day and you’ll have an approximate date of when the canistor will be empty. Some patients also mark the canistor each time they take a dose. A good recommendation is to always order a new canistor whenever a canistor is opened for the first time. This ensures a backup is always readily available should the canistor become empty or clogged.
What are some other nursing conditions when administering metered-dose inhalers (MDI)?
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A good respiratory assessment is important, especially noting rate and rhythm of breathing and any evidence of hypoxia. Listening to lung sounds before and after administration will give an indication as to the effectiveness of the bronchodilator. Wheezing should diminish following the administration of a bronchodilator.
The Respiratory System - Bronchodilators and Corticosteroids
Roach, Chapter 37
What is a bronchodilator?
What respiratory diseases or disorders are commonly treated with a bronchodilator?
Chronic obstructive pulmonary disease (COPD)
Albuterol (Ventolin) is an example of a sympathiomimetic bronchodilator (mimics the effects of the sympathetic nervous system). What other drug have you learned about that also mimics the sympathetic nervous system?
What is the inverse relationship of a bronchodilator and cardiovascular function?
Drugs causing bronchoconstriction cause vasodilation, thus lowering blood pressure, and also decrease heart rate. Think metaprolol. Recall that one of the nursing considerations of a person receiving a beta-blocker was to monitor lung sounds for wheezing.
Bronchodilation is accompanied with vasoconstriction. Vasoconstriction is accompanied with bronchodilation. Bronchoconstriction is accompanied with vasodilation. Vasodilation is accompanied with bronchoconstriction.
Given this information, what two side effects are associated with bronchodilators?
How is albuterol (Ventolin) administered?
What is a corticosteroid?
What respiratory diseases or disorders are commonly treated with an inhaled corticosteroid?
COPD
What are the side effects of a corticosteroid inhalant?
Hoarseness
Cough
Fungal infection of mouth or throat
Vertigo
Headache
Fluticasone propionate (Flovent) is an inhaled corticosteroid. Why aren’t the side effects of fluticasone propionate (Flovent) the same as the corticosteroid Prednisone?
How is fluticasone propionate (Flovent) administered?
What is a Metered-Dose Inhaler (MDI)?
How is an MDI administered?
2. Remove the cap from the mouthpiece.
3. Exhale completely.
4. Hold the inhaler system upright.
5. Place the mouthpiece into the mouth and close lips.
6. Press the top of the inhaler while taking a slow, deep breath.
7. Hold the breath for 10 seconds before slowly exhaling.
8. If more than one inhalation (puff) is required, wait about one minute between.
9. Rinse the mouth after use.
10. Cleanse the mouthpiece.
Watch Video
What is a spacer?
How is an aerochamber (spacer) used?
Watch Video
When both medications are ordered, why should the bronchodilator be given before the corticosteroid?
How can you tell when a canistor is nearly empty?
What are some other nursing conditions when administering metered-dose inhalers (MDI)?
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